Why is the quality of care in some hospitals better than others? It is well documented that the U.S. health care system is marked by problems of inefficiency, poor coordination, and highly variable quality of care. The research literature has focused on a number of factors that could affect quality, but relatively little is known about the ways in which hospitals are internally managed. This application seeks funding to conduct a survey that will produce an entirely new set of data on management practices in a large sample of U.S. hospitals. By management practices, we mean the policies, systems, and standards that are used to guide hospital operations, performance measurement, clinical relationships, and employee incentives. Measuring these practices is not easily accomplished through traditional surveys or reliance on administrative data. We will use an innovative survey methodology that represents a significant breakthrough in its ability to elicit true information on organizational practices and to minimize the gaming of responses toward favorable scores. The overall goal of this application is to measure management practices in U.S. hospitals and their association with patient outcomes. The specific hypothesis behind the proposed research is that there are managerial techniques that are associated with better patient outcomes, but not widely adopted or disseminated within the hospital sector. The survey, and its linkage with existing data on hospitals, patient outcomes, and quality indicators, will address an important gap in the knowledge about the policies and practices that define how a hospital operates. The proposed study would be the first to open the "black box" of U.S. hospital management, and to assess its importance in patient outcomes. This proposal has three specific aims:
Specific Aim 1. Survey and measure management practices in 800 U.S. hospitals.
Specific Aim 2. Explain why management practices vary across hospitals.
Specific Aim 3. Assess the relationship between management practice scores and the quality of patient care.
This research aims to improve the understanding of these tools - their frequency of use as well as their apparent effectiveness - so that good tools can be promoted and more quickly adopted by hospitals, with the ultimate goal of improving patient outcomes.

Public Health Relevance

It is likely - but not known - that effective management practices are not widely disseminated among U.S. hospitals. We propose to conduct a survey that will produce an entirely new set of data on management practices in a large sample of U.S. hospitals. The survey, and its linkage with existing data on hospitals, patient outcomes, and quality indicators, will address an important gap in the knowledge about the policies and practices that define how a hospital operates.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS018466-04
Application #
8299938
Study Section
Health Systems Research (HSR)
Program Officer
Hagan, Michael
Project Start
2009-09-30
Project End
2014-03-31
Budget Start
2012-08-01
Budget End
2014-03-31
Support Year
4
Fiscal Year
2012
Total Cost
Indirect Cost
Name
Oregon Health and Science University
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
096997515
City
Portland
State
OR
Country
United States
Zip Code
97239
McConnell, K John; Lindrooth, Richard C; Wholey, Douglas R et al. (2013) Management practices and the quality of care in cardiac units. JAMA Intern Med 173:684-92